Economics, Health Care

What we learned about Obamacare today: Dec 12, 2013

HealthCare.gov

HealthCare.gov

1.) This afternoon “the Department of Health and Human Services said it was ‘strongly encouraging’ insurers to help the department fix a raft of problems created by the rocky rollout of President Obama’s health care law,” Philip Klein reports. “Among the guidance the HHS announced”:

*It is requiring insurers to accept payments until Dec. 31 for coverage starting on Jan. 1. It is also “urging” insurers to give individuals more time beyond that to pay for coverage.

*In a press release, HHS said it was also “strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes or if the provider was listed in their plan’s provider directory as of the date of an enrollee’s enrollment.”

On a conference call, an HHS spokeswoman emphasized: “We are just proposing it as an option and we’re encouraging issuers. There is no requirement.”Translation: HHS has a huge mess on its hands and it hopes that by getting ahead of this news, it can foist the blame for the problems on insurers.

2.) AEI’s Tom Miller writes that the end of Obamacare is “just the beginning of better health care”:

Obamacare can’t be mended. A simple return to the pre-ACA world is no solution either…. First, allow willing parties to find each other in more transparent and accountable marketplaces. Dial back the ACA’s dense set of counterproductive benefits mandates and insurance price controls. Second, replace the unpopular and ineffective individual mandate to purchase Washington-approved insurance with new incentives to maintain continuous coverage instead….

The best way to encourage greater competition and innovation in health care delivery is to allow it to take place without the stifling regulation and price suppression of ACA-like policies. Taxpayer-funded health programs then can recognize, ratify, reward, and publicize what was actually invented elsewhere.

3.) The Centers for Medicare and Medicaid Services announced today that “As many as 135,000 individuals enrolled in federally funded programs for people with pre-existing conditions will be given a few more weeks to find replacement coverage for next year through Obamacare’s health insurance exchanges.” Sarah Kliff reports “the state-based ‘high risk pools’ set up in 2010 will continue to offer coverage to existing members through the end of January.”

4.) Yesterday, House Science Committee Chairman Lamar Smith (R-TX) and 21 other Republican members sent a letter to the White House about the health exchange website’s security issues, “requesting information and an explanation about what your Administration is doing to address the security risks and privacy concerns surrounding HealthCare.gov.” Read the full letter here.

5.) The Wall Street Journal says “HHS won’t disclose the enrollment data that really matter”:

A charitable reading suggests that ObamaCare’s net enrollment stands at about negative four million. That’s the estimated four million to five and a half million people who had their individual health plans liquidated as ObamaCare-noncompliant—offset by the 364,682 who have signed up for a plan on a state or federal exchange and the 803,077 who have been found eligible to receive Medicaid….

The larger problem is that none of these represent true enrollments. HHS is reporting how many people “selected” a plan on the exchange, not how many people have actually enrolled in a plan with an insurance company by paying the first month’s premium, which is how the private insurance industry defines enrollment…. HHS also hasn’t built the tools that would allow people to pay through the exchange. Customers must contact their putative insurer, who may not be aware of their existence because the federal exchanges continue to produce corrupted data on the “back end” that are crucial for insurers….

In other nondisclosure news, the House Oversight Committee turned up letters Wednesday showing that HHS ordered the private contractors partly responsible for the Healthcare.gov fiasco not to cooperate with congressional investigations or hand over documents.

6.) David Francis says there’s “an obscure rule” that “could boost Obamacare enrollment.” “However, officials may have a trick up their sleeve. It’s a little-known provision of the law called special enrollment — and it might be Obamacare’s secret weapon after open enrollment ends, according to health policy experts. Here’s the deal: The end of open enrollment does not mean the end of enrollment — it’s called ‘special enrollment.’”

7.) Bob Laszewski offers “a few observations after 10 weeks of Obamacare implementation.” Here are four:

*In states where the exchange has been running at least adequately for many weeks now, the enrollment numbers are far from what I would have expected.

*If an enrollee does not pay their first month’s premium by December 31, their enrollment will be void. So far, the health plans I have spoken to have seen only about 20% of their enrollees pay their premium.

*The Obama administration has still not built the reconciliation computer system needed to clean up the remaining enrollment data issues between HealthCare.gov and the health plans.

*There have been reports of HealthCare.gov enrolling exchange eligible people in Medicaid instead of the private plan they want (Federal Exchange Sends Unqualified People to Medicaid). No one seems to know how big a problem this is.

8.) AEI’s Scott Gottlieb discusses how “an attempt to alter Medicare may let Washington dictate how doctors treat patients”:

Imagine if a provision in ObamaCare allowed Health and Human Services Secretary Kathleen Sebelius to dictate directly to doctors which services they could and could not provide their patients—what individual tests they could conduct, which treatments they could offer, and medicines they could prescribe. Americans would be outraged.

Yet some Republicans on Capitol Hill are about to help Democrats pass such a provision for Medicare patients. The Senate Finance Committee is set to vote on permanent “doc-fix” legislation Thursday that grants the federal government broad new authority to determine “applicable appropriate use criteria” for the full range of outpatient medical services delivered to seniors.

9.) Oregon update: the state has managed to enroll only 44 people, “despite spending $300 million,” writes Philip Klein.

10.) Over at Kaiser Health News, Julie Appleby writes on a study that finds “marketplace plans’ networks are very small”:

To keep premium prices down for insurance being sold to individuals and small businesses in the new online marketplaces, insurers have created smaller networks of hospitals. But consumers and policy experts have wondered, just how small? Turns out many are very small.

“About two-thirds of hospital networks on the exchanges are narrow or ultra-narrow,” said Paul Mango, a director at the consulting firm McKinsey & Co., at a conference of insurance industry leaders in Washington Thursday.

11.) Robert Grayboyes and Patrick Paule explain just why millions are losing their health insurance policies because of Obamacare, saying “ACA supporters claim the cancelled plans were ‘subpar.’ But in fact, many or most cancelled plans simply did not fit the ACA’s arbitrary cookie-cutter standards; the ACA forces insurers to offer sameness, not quality.…. If you like your plan, you can keep your plan-provided that the AV is 59 (bronze), 71 (silver), 82 (gold), or 90 (platinum). But if your plan covers 66 percent of your expenses, or 73, 85, or even 98, you can’t keep it. You are cancelled. It is bad, subpar insurance, and you go to detention hall (read: Healthcare.gov) indefinitely.” They go on to add:

One of us (Pat) works with a small employer whose insurance policy has a 96.9 percent AV. The employer pays 100 percent of the employees’ premiums. The ACA views this plan as subpar because it pays too high a percentage of the employees’ medical costs. To be ACA-compliant, this group will must now provide fewer benefits. When employees get sick, the ACA insists that they face higher out-of-pocket costs.

If you think this is a problem just for the 5 percent of Americans (15 million plus) who get their insurance through the individual market, think again. Tens of millions of Americans who get their insurance through small-business plans are likely to experience similar waves of cancellations when their policies come up for renewal in late 2014 and in 2015. In 2016, the small-business rules will expand to include employers with up to 99 employees, meaning that all told, 40 to 50 million individuals (plus millions of family members) could be vulnerable.

12.) Did you know: as of yesterday, Michigan has joined 23 other states in “banning abortions in [their] Obamacare plans.”

13.) There is an Obamacare push launching today featuring numerous celebrities, such as Adam Levine. The campaign is called “Tell a Friend — Get Covered.” According to the website, the campaign will even include “an 8-hour, live-streamed event on January 16.” See one of the video examples below.

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